The new chief master sergeant of the Air Force is taking on two of the most universally hated topics for enlisted airmen: waist measurements and enlisted performance reports.

"They are languishing issues," Chief Master Sergeant of the Air Force James Cody told Air Force Times. "Everybody knows that. You continually report on them. We get it. Our airmen talk to us. I can't go to an all-call and not get a question on [them]."

Over the next six months, Cody will look at airmen's frustrations with the waist measurement component of the physical training test and enlisted performance reports to see if any solutions are available.

"If we can't fix this thing in six months, we need to come to terms with the fact that it just may be too hard to fix, or it's not worth where we're putting all our energy to try to get after it," Cody said in a Feb. 21 interview. "We need to go after those things that we can affect change in, that need to be changed in our Air Force. We owe it to our airmen. We owe it to everybody else. We have to move forward."

By July, Cody expects to have a decision on whether waist measurements should be part of the PT test. The Air Force limits male airmen to a waist circumference of 39 inches and female airmen to 35.5 inches, regardless of height or age.

"There's airmen out there that will articulate that, ‘Hey, I can pass every component of the test except for waist measurement: I can max my pushups; I can max my run; I can max my situps, but I still fail because I have too big of a waist and I'm a big person.'" Cody said. "There's lots of different reasons why that might be."

Airmen whose waist sizes bust the maximum fail their entire PT test.

The Air Force understands that this happens, but science has indicated that airmen with waist measurements beyond the PT test limits are at greater risk of disease down the road, he said.

So the Air Force will look at whether it is feasible to have the waist circumference or some other health assessment separate from the PT test.

"We're not convinced that we will separate them," Cody said. "They are combined today. We want to understand: Should we separate them?"

It is not yet known whether the Air Force would continue with waist measurements or use another assessment, such as airmen's neck sizes, Cody said. Any new health assessment would still have to determine if airmen are meeting standards.

"If they were to be separated — and I emphasize ‘if' — we would have to say what is the best way to determine overall health indicators to say whether somebody was unhealthy, getting unhealthy, really unhealthy — whatever those things are," he said. "We'd have to have professionals tell us what is the best way to assess that, and we would do that."

The waist measurement component of the PT test has been adjusted before: In 2009, top leaders agreed to move the threshold for a perfect score to 31.5 inches for women, up from 28 inches, and to 35 inches for men instead of 32.5 inches. The maximums of 35.5 inches for women and 39 inches for men remained unchanged.

Measuring good health

Experts are divided about how reliable waist circumferences are in predicting health problems, such as diabetes, high blood pressure and heart disease.

Investigators have determined that waist circumference is more reliable in determining health risks than the body mass index, a measure of body fat, said Dympna Gallagher of the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital.

One reason waist circumference is such a strong indicator is that it measures how much abdominal fat you have, and that is a more important risk factor than total body fat, Gallagher said.

However, there are two types of body fat: One that is right below the skin and one that is buried deeper, she said. The deeper abdominal fat poses the greater health risk. People with the same waist size can have different levels of the more dangerous fat.

"With that all said, epidemiological data — and this is in very large-scale studies — clearly shows that waist circumference is clearly associated with these metabolic risk factors," Gallagher said.

While it's possible for someone to have a 40-inch waist and not be at increased risk of health problems, it would not be common, said Robert Eckel, who teaches medicine at the University of Colorado Anschutz Medical Campus.

"When the waist circumference is bigger, the interabdominal fat typically is bigger, and when the interabdominal fat, meaning what's in the belly inside the abdomen, is more, then you get more liver exposure to all the fatty acids," said Eckel, a past president of the American Heart Association.

However, measuring waist circumference is not a perfect system, so there are exceptions, he said. For example, people with Asian or Latin American heritage can have smaller waist circumferences and still have too much abdominal fat, he said.

"Whereas in African Americans, in black people, actually the waist circumference can be larger and a lot of that fat is not within the abdomen, it's around the surface of the belly," Eckel said. "In general, that type of fat distribution wouldn't be as harmful."

But determining exactly which waist circumference measurements indicate a high risk of heath problems is "fuzzy," said David Levitsky of Cornell University in Ithaca, N.Y.

To be an accurate predictor of health problems, waist circumference measurements need to take into account height, said Levitsky, a professor of nutrition and psychology.

"If someone is 7 foot, for example, and has an abdominal circumference of 36 inches, I doubt very much if BMI is going to be in dangerous ranges; but if one were at [5 feet, 5 inches] then, obviously, there would be a problem," he said.

Another variable is physical fitness, which is not reflected in waist measurements, Levitsky said.

"There is some interesting data showing that if you are physically fit, then your BMI doesn't mean a damn thing, so you could have a large waist circumference or a large BMI, but if you're physically fit and you look at mortality and morbidity data, you're going to live just as long as anybody else," he said.

Clinical tests would provide a much more accurate indication of whether someone is at increased risk of health problems, but they are much more expensive than measuring one's waist, Levitsky said.

"It's not accurate, but it's cost effective and you will find those people who have large abdominal fat stores that will be at high risk, but you're going to make a lot of mistakes, too," he said.

However, the Air Force contends that scientific evidence overwhelmingly shows that measuring the abdominal circumference is the best way to assess health risks stemming from abdominal fat, said Lt. Col. Colin Huckins, chief of the Promotion, Fitness and Evaluation Policy Branch.

"In fact, the AC [abdominal circumference] measurement has numerous advantages, especially in facing the challenge of assessing the large Air Force population in that it is a practical, highly reproducible, single measurement, unrelated to stature and age of which airmen can easily track their personal progress through a change in pant or belt size," Huckins said in an email.

Huckins disputed the notion that a person's height affects how much of an indicator the waist circumference is in determining health risks.

"In other words, being 6 feet tall with a 40-inch waist does not put you in a lower health risk category than being 5 feet 7 inches tall with the same 40-inch waist," he said. "This is confirmed in a multi-study assessment of over 7,600 subjects."

EPR system ‘broken'

Cody will also wade into the longstanding issue of EPR inflation. Airmen have complained for years that the top rating of 5 is handed out so freely that anything less is a career-ender. And with four out of five airmen receiving the highest rating of "truly among the best," airmen complain that the evals are useless.

"Here's the bottom line: We are going to come up with a system that clearly values performance before everything else," Cody said. "That does not mean we won't value other things. We will just value performance first, and it will be the heaviest weighted factor."

In 2009, then-Chief Master Sergeant of the Air Force James Roy called for more honest assessments, but the percentage of airmen who received perfect 5s on the EPRs only dropped from 85.3 percent in fiscal 2009 to 83 percent in fiscal 2012.

"This is a frustrating system for all of us," Cody said. "Much of it is in the deployment of it, not in the actual guidance and things that we have in place."

Air Force Times readers who are raters have often complained that they are expected to give airmen a 5 on their EPRs unless they can provide volumes of justification for giving an airman a lower score. Even then, raters' superiors can overrule them and give the airman a 5.

Recently, the Air Force had to make clear that airmen who receive a referral report for failing to meet physical fitness standards, for substandard job performance or for a disciplinary action cannot get a 5 on their EPRs.

Retired Chief Master Sergeant of the Air Force Jim Binnicker, the primary architect of the EPR, said it was intended to allow supervisors to recognize their best performers without harming other airmen's chances of promotion.

"Maybe I had on rose-colored glasses that I thought, ‘Well, maybe if we give people a chance to not violate the integrity and report on people based on their performance in a truthful way, that they'll take this opportunity and actually do it,'" he said.

Binnicker said he expected most airmen to score a 3 on the EPR, but when he briefed the new performance report to Air Force leaders at a semiannual Corona meeting, it quickly became clear that commanders expected the majority of airmen to get 5s.

"Now we have to administer another set of mechanisms to rack and stack people because we've given them all 5s," he said. "All that is, to me, is admitting the system is broken."

There are not many ways to remove inflation from performance reports, because there is no way to "legislate" what supervisors give airmen on the report cards, Binnicker said.

"You could put some kind of quota systems on the supervisors and say, ‘You will only give this many 3s, 4s and 5s and if you violate that, then I'm going to give you a 3,' but that's leadership through fear and I'm not a proponent of that," he said.

Another option is to take EPRs out of the promotion system, Binnicker said. Since virtually all airmen get 5s, everyone gets the maximum number of points toward promotion.

"If everyone is getting 135 points, it negates the whole thing, so you could take it out and it wouldn't make any difference," he said. "Then, I think, supervisors would be more inclined to tell the truth about performance because they know it's not going to directly affect their career, their future."

Since this is not a new issue for the Air Force, Cody is compiling all the data available on EPRs to see if the problems stem from concept or execution, he said.

"The previous chief master sergeants of the Air Force that came before me worked this issue, responded to this issue, dealt with this issue. I want to be respectful of the fact that a lot of smart people in our Air Force have looked at this and I don't know everything that they knew when they made the decisions that they did," Cody said.

Once the EPR review is done, Cody is calling a hard stop on the discussion.

"We are going to look at it over the next six months and we're going to make a determination whether we change it or not — and then we're not looking at it again for our tenure," he said.

Next up: CBTs

One issue that Cody is not ready to assign a deadline for is a decision on just how much computer-based training airmen need.

"It's really about how we value their time and what we're asking them to do with that time: Is all this necessary training?" he said.

When Air Force Times asked readers in January what Cody should tackle, one technical sergeant said airmen need more hands-on training and less time sitting in front of a computer.

"It's basically like if you were to do a task in your car, like if you were to say, ‘You know what, I don't like the motor in my car; I want to change it out,'" said the airman, who did not want to be identified. "It's like you watching a YouTube video on how to change your motor out in your car. How confident would you feel trying to do it after the video? You could only watch it once."

Cody has heard anecdotes like this, but there are plenty of other airmen who believe CBT is relevant to what they do and they prefer that method to taking hours out of their day to go someplace else for training.

So the Air Force needs to figure out how many CBT classes it has, which ones are the priority and who needs them so supervisors can help manage airmen's time productively, Cody said.

"Both the chief and I want to address it," he said. "We want to be able to respond back to our airmen and tell them, ‘OK, we've looked at this'; a better explanation, a better prioritization of what we're doing and why we're doing it. We certainly want to eliminate things that we don't need to do."